Provider Demographics
NPI:1992226021
Name:ANDERSON, LISA NICOLE (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:NICOLE
Last Name:ANDERSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 FOREST LN STE C614
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6856
Mailing Address - Country:US
Mailing Address - Phone:972-566-7499
Mailing Address - Fax:972-566-6428
Practice Address - Street 1:7777 FOREST LN STE C614
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6856
Practice Address - Country:US
Practice Address - Phone:972-566-7499
Practice Address - Fax:972-566-6428
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1490552086X0206X
TX664589390200000X
TXV26862086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program